Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
J Infect Public Health. 2020 Jan;13(1):110-117. doi: 10.1016/j.jiph.2019.07.004. Epub 2019 Jul 20.
Although the specific etiology of Henoch-Schonlein purpura (HSP) is still unknown, several kinds of infectious triggers have been proved to participate in its pathogenesis. The objectives of present study were to analyze the association of the infectious triggers with childhood HSP in Anhui province, China.
1200 HSP children were recruited from January 2015 to December 2017. Serum antistreptolysin O titer, TORCH, Epstein-Barr virus, helicobacter pylori (HP), Mycoplasma antibodies (MP-Ab), tubercle bacillus antibody (TB-Ab), respiratory pathogens (legionella pneumophila, chlamydia pneumoniae, adenovirus, respiratory syncytial virus, influenza A virus, influenza B virus, rickettsia, parainfluenza virus) were determined. Patients' histories were obtained by interviews and questionnaires.
The annual incidence of HSP was 8.13-9.17 per 100,000. HSP occurred more commonly in spring and winter than in summer with an obvious west-to-east gradient. On admission, several potential infections were identified in 611 cases (50.92%). The infectious agents including streptococcus, HP, MP, parainfluenza, respiratory syncytial virus, TB and toxoplasma gondii were identified in 205 cases (17.08%), 71 cases (5.92%), 58 cases (4.83%), 6 cases (0.5%), 1 case (0.08%), 1 case (0.08%) and 1 case (0.08%) respectively. 123 cases (10.25%) relapsed or recurred more than one time; the mean number was 2.92, and the mean interval was 11.4 weeks. The infection was the most frequent trigger regardless of clinical phenotypes and relapse/recurrence. Symptomatic treatment plus adjunctive anti-infectious agents could significantly improve the remission rate of purpura in the infectious cases (x=24.60, p<0.01).
Streptococcus is the most frequent infectious agent in HSP children regardless of clinical phenotype or relapse/recurrence. The complete elimination of infectious triggers may help relieve cutaneous purpura.
虽然过敏性紫癜（HSP）的确切病因仍不清楚，但已证实多种感染性触发因素参与其发病机制。本研究的目的是分析感染性触发因素与中国安徽省儿童 HSP 的关系。
2015 年 1 月至 2017 年 12 月，共招募 1200 例 HSP 患儿。检测血清抗链球菌溶血素 O 滴度、TORCH、EB 病毒、幽门螺杆菌（HP）、肺炎支原体抗体（MP-Ab）、结核杆菌抗体（TB-Ab）、呼吸道病原体（嗜肺军团菌、肺炎衣原体、腺病毒、呼吸道合胞病毒、甲型流感病毒、乙型流感病毒、立克次体、副流感病毒）。通过访谈和问卷调查获取患者病史。
HSP 的年发病率为 8.13-9.17/10 万。HSP 多发生于春季和冬季，且呈明显的由西向东梯度分布。入院时，611 例（50.92%）患儿存在潜在感染。感染病原体包括链球菌、HP、MP、副流感病毒、呼吸道合胞病毒、结核分枝杆菌和弓形体，分别为 205 例（17.08%）、71 例（5.92%）、58 例（4.83%）、6 例（0.5%）、1 例（0.08%）、1 例（0.08%）和 1 例（0.08%）。123 例（10.25%）复发或再发>1 次，平均次数为 2.92 次，平均间隔时间为 11.4 周。感染是最常见的触发因素，无论临床表型如何或是否复发/再发。症状性治疗加辅助抗感染药物可显著提高感染性 HSP 患儿的缓解率（x=24.60，p<0.01）。
无论临床表型或复发/再发，链球菌均为 HSP 患儿最常见的感染性病原体。彻底消除感染性触发因素可能有助于缓解皮肤紫癜。
